<div class="box box-primary" xmlns:th="http://www.thymeleaf.org">
	<div class="box-header with-border">
		<h3 class="box-title">患者信息</h3>
	</div>

	<form id="patientForm1" class="form-horizontal">
		<input id="type" type="hidden" th:value="${type}"/>
		<input id="pId" type="hidden" th:value="${pId}"/>
		<div class="box-body">
			<div class="form-group">
				<label for="patient_name" class="col-md-2 control-label">患者名称<span class="colorred">*</span>：
				</label>
				<div class="col-md-4">
					<input id="patient_name" class="form-control" type="text" name="patient_name" bindname="patient_name" />
				</div>
				<label for="idnumber" class="col-md-2 control-label">身份证号<span class="colorred">*</span>：
				</label>
				<div class="col-md-4">
					<input id="idnumber" class="form-control" type="text" name="idnumber" bindname="idnumber" />
				</div>
			</div>
			<div class="form-group">
				<label for="sex" class="col-md-2 control-label">性别<span
					class="colorred">*</span>：
				</label>
				<div class="col-md-4">
					<select id="sex" name="sex" bindname="sex"></select>
				</div>
				<label for="age" class="col-md-2 control-label">年龄<span class="colorred">*</span>：
				</label>
				<div class="col-md-4">
					<input id="age" class="form-control" type="text" name="age" bindname="age" />
				</div>
			</div>
			<div class="form-group">
				<label for="weight" class="col-md-2 control-label">体重
				</label>
				<div class="col-md-4">
					<input id="weight" class="form-control" type="text" name="weight" bindname="weight" />
				</div>
				<label for="height" class="col-md-2 control-label">身高(cm)
				</label>
				<div class="col-md-4">
					<input id="height" class="form-control" type="text" name="height" bindname="height" />
				</div>
			</div>
			<div class="form-group">
				<label for="nation" class="col-md-2 control-label">民族
				</label>
				<div class="col-md-4">
					<select id="nation" name="nation" bindname="nation"></select>
				</div>
				<label for="phone" class="col-md-2 control-label">联系电话<span  class="colorred">*</span>：
				</label>
				<div class="col-md-4">
					<input id="phone" class="form-control" type="text" name="phone" bindname="phone" />
				</div>
			</div>
			<div class="form-group">
				<label for="self_reported" class="col-md-2 control-label">主诉
				</label>
				<div class="col-md-10">
					<textarea id="self_reported" class="form-control" rows="4"  name="self_reported" bindname="self_reported"  placeholder="主诉信息 ..."></textarea>
				</div>
			</div>
			<div class="form-group">
				<label for="history" class="col-md-2 control-label">病史
				</label>
				<div class="col-md-10">
					<textarea id="history" class="form-control" rows="4"  name="history" bindname="history"  placeholder="病史 ..."></textarea>
				</div>
			</div>
			<div class="form-group">
				<label for="prediagnose" class="col-md-2 control-label">预诊断
				</label>
				<div class="col-md-10">
					<textarea id="prediagnose" class="form-control" rows="4"  name="prediagnose" bindname="prediagnose"  placeholder="预诊断 ..."></textarea>
				</div>
			</div>
			
		</div>
		<div class="box-footer">
			<button id="cancel" type="button" class="btn btn-default pull-right">取消</button>
			<button id="save" type="button" class="btn btn-info pull-right mr30">保存</button>
		</div>
	</form>
</div>
<script th:if="${projectModel=='dev'}" th:src="@{/static/js/business/remote/form.js(v=${#dates.createNow().getTime()})}"></script>
<script th:if="${projectModel=='product'}" th:src="@{/static/js/remote/register/form.js}"></script>